Aditya Birla Health Insurance Co. Limited

Port in to Aditya Birla Health Insurance

Terms & Conditions.
Unique features of the activ one max plan

Go Premium-Free on Renewal with 100% HealthReturns.

100% Hospital Bills Covered

No Limit on Hospitalization Expenses

Unlimited Refill of Sum Insured from the 2nd Claim

Get 6X Cover by the 6th Year Irrespective of Claims

Pre & Post Hospitalization Expenses Covered

UNDERSTANDING THE ACTIV ONE MAX PLAN BETTER

Why Aditya Birla Health Insurance?

2.5 Crore+

Lives Insured

11,000+

Cashless Hospitals

21 Lac+

Claims Settled

96%

Claim Settlement Ratio

Understand Activ One MAX Features

Testimonials

ELIGIBILITY AND SPECIFICATIONS

Eligibility

Entry Age (Adult):

Minimum - 18 Years, Maximum - No capping

Entry Age (Child):

Dependent Child (Floater / Multi Individual) - 91 Days to 25 Years

Individual – minimum age of entry - 5 Years

Policy Type:

Individual & Family Floater

Tenure:

1 / 2 / 3 Years

Family Definition:

Up to 2 Adults, 4 Children

Relationship Covered:

Individual : Self, legally married spouse or live-in partner (same or opposite sex), son, daughter, brother, sister, grandson, granddaughter, son-in-law, daughter-in-law, brother-in-law, sister-in-law, nephew, niece, parents and parents-in-law

Floater: Self, legally married spouse or live-in partner (same or opposite sex), dependent Children (Natural / legally adopted), parents and parents-in-law

Waiting Periods

Pre-Existing Diseases Waiting Period:

3 years

Specific Diseases Waiting Period:

2 years

Initial Waiting Period (Excluding Accidental Hospitalization):

30 days

Please add section 41 of Insurance Act, 1938.
Please add standard Product disclaimer.

Exclusions

Expenses solely for diagnostic evaluation; Non-related diagnostic expenses not incidental to current treatment
Expenses for enforced bed rest admissions; Custodial care for daily living; Services for terminally ill individuals' needs.
Self-initiated obesity surgery without the advice of a doctor; Inclusion criteria for surgery: BMI ≥ 40, age > 18, clinical-protocol supported surgery; BMI 35+ with comorbidities like severe sleep apnea, coronary heart disease, Obesity-related cardiomyopathy, uncontrolled Type-2 Diabetes Mellitus covered after failed non-invasive weight loss methods.
Expenses for changing body characteristics to opposite sex.
Cosmetic/plastic surgery unless for reconstruction after Accident, Burn, Cancer, or to remove immediate health risk, certified by Medical Practitioner.
Treatment due to participation in hazardous/adventure sports, e.g., mountaineering, scuba diving, motor racing; Not limited to specified activities.
Treatment resulting from Insured Person's criminal acts.
Treatment from providers listed on website; Emergency care paid till stabilization, not full claim.
Over-the-counter dietary supplements; Exceptions for prescribed supplements during hospitalization or day care.
Treatment for refractive error 7.5 dioptres.
Unproven treatments, services, supplies lacking medical documentation.
Expenses for sterility, infertility treatments, contraception, assisted reproduction, gestational surrogacy, sterilization reversal.
Childbirth-related medical expenses (except ectopic pregnancy); Miscarriage expenses (unless due to accident) and lawful pregnancy termination.
Any illness or injury due to war, rebellion, armed resistance, acts of terrorism and nuclear or radiological emissions.
Suicide/self-harm, illegal acts, injury from alcohol/intoxicating substance use, and non-prescription drug use.
  • Routine exams and check-ups, except as specified in Annual Health Check-up terms.
  • Circumcisions, unless medically necessary or part of an illness or injury treatment plan.
  • Conditions treatable on an outpatient basis without hospitalization
  • Preventive care, vaccinations (except post bite), and physical/psychiatric/physiological examinations or testing
  • External Abnormalities to a new-born baby
  • Dental/oral treatment for natural teeth and gingiva, unless required during Hospitalization due to an Accident.
  • Any form of AYUSH treatment, unless expressly mentioned in the policy document.
Hearing aids, spectacles, wigs, prosthesis, medical equipment, and cochlear implants, unless specified in optional coverage*- Durable Medical Equipment Cover.
Items listed in Annexure (I) Lists I, II, III, and IV are not covered unless they are part of in-patient hospitalization; this exemption does not apply if Claims Protect is included in the base benefit or opted as an optional cover* and specified in the Policy Schedule.
Treatment by unregistered practitioners, unlicensed and unauthorized practitioners' fees, and treatments by family members or resident practitioners without pre-approval.
Treatment taken outside India.